| NPI | 1912458456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 26790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 59150) |
| 207Q00000X Family Medicine (Licence: IL 77437) | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2022-04-12 |