| NPI | 1033116488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201101511) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD19242) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2013-11-11 |