| NPI | 1376741355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 53359) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 19838) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2024-06-12 |