| NPI | 1699737056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO2092) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101014417) |
| 207Q00000X Family Medicine (Licence: CA 20A10274) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2022-01-25 |