| NPI | 1790814630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 1484) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 2126) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2023-11-02 |