| NPI | 1730491317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TN 57078) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 262418) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2023-06-20 |