| NPI | 1942705637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 71715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A163977) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-11-07 |