| NPI | 1417053117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2014006968) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD24824) |
| 207Q00000X Family Medicine (Licence: HI MD7151) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2019-05-07 |