| NPI | 1396189403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 54696) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101275969) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2022-11-01 |