| NPI | 1548476252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 43739) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 18144) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2024-07-24 |