| NPI | 1669452793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 12602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 17953) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2020-02-05 |