| NPI | 1407410434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO04697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018982) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2024-04-25 |