| NPI | 1972522803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 95535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS 11295) |
| 207Q00000X Family Medicine (Licence: TN DO3953) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-05-30 |