| NPI | 1720082548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN MD21614) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 21614) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2018-03-17 |