| NPI | 1356315063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 31247) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME74000) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2020-03-11 |