| NPI | 1962434878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 012587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 12888) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2013-11-30 |