| NPI | 1821127093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN MD26391) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 26391) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2011-06-29 |