| NPI | 1760671655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 42724) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 42724) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TN 42724) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2023-10-30 |