| NPI | 1386625960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 9041) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 1925) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2020-03-05 |