| NPI | 1801862313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 2329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201997) |
| 207Q00000X Family Medicine (Licence: TN DO0000002329) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2026-02-25 |