| NPI | 1962524355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN I-1147) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2023-03-07 |