| NPI | 1760411813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 19093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 27217) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2020-03-18 |