| NPI | 1760821953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 64522) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-43056) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2022-03-01 |