| NPI | 1588656730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD 37824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-3513) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2009-10-08 |