| NPI | 1548782568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 70448) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 53770) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2024-08-14 |