| NPI | 1760645113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 52361) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 25411) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2015-10-06 |