| NPI | 1871622969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 59283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 20403) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2020-02-25 |