| NPI | 1730268939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 20062) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 34974) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2014-07-10 |