| NPI | 1891926440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 49026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 13062941-1205) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2023-08-16 |