| NPI | 1780206359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 64732) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101284024) |
| Enumeration Date | 2020-05-17 |
| Last Update Date | 2026-01-05 |