| NPI | 1518962968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C8428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000031428) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2023-03-07 |