| NPI | 1619170701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 71075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 47474) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2014-02-03 |