| NPI | 1750444139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 36080) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD36080) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2023-05-16 |