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 |