| NPI | 1790700771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TN 35091) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 35091) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: TN 35091) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2024-05-12 |