| NPI | 1871770123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 46218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 80815) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2020-03-12 |