| NPI | 1467463299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 28812) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 19276) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: TN MD0000028812) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2023-04-13 |