| NPI | 1497914386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 47513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 21674) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2011-08-29 |