| NPI | 1659535557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO000001897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 1079) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2025-12-30 |