| NPI | 1417359936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 74628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 56554) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2025-06-24 |