| NPI | 1538521620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 67357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 59949) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-09-06 |