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 |