| NPI | 1417923293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 40959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200101487) |
| 207Q00000X Family Medicine (Licence: GA 038933) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2020-02-19 |