| NPI | 1093705576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO000623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 28293) |
| 207Q00000X Family Medicine (Licence: SC 0200) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2015-10-20 |