| NPI | 1790708097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 45857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 12113) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-12-21 |