| NPI | 1871570903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 59735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301407434) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2019-09-17 |