| NPI | 1710140249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 52415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 25511) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2017-02-02 |