| NPI | 1437464336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 55403) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2013-0703) |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2021-09-09 |