| NPI | 1750373957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD19814) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E1477) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2008-04-04 |