| NPI | 1730384736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN MD12063) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD12063) |
| 2083A0300X Preventive Medicine Addiction Medicine (Licence: TN MD12063) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2022-07-20 |