| NPI | 1457329385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO1166) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 1166) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2018-08-07 |