| NPI | 1003808924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M12455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000027731) |
| 207Q00000X Family Medicine (Licence: LA MD.204465) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2014-09-26 |