| NPI | 1770783151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 48352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010014105) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2018-07-26 |