| NPI | 1700170602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 2562) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 172682) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2023-08-10 |