| NPI | 1861552119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 57752-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD52028) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2016-01-06 |