| NPI | 1578590725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 1634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 163) |
| 261QP2300X Clinic/Center, Primary Care (Licence: TN 1634) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2022-04-28 |