| NPI | 1851443063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 47412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 36798) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2022-03-30 |