| NPI | 1982684361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 18827) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 18827) |
| 208600000X Surgery (Licence: TN 18827) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2024-05-27 |