| NPI | 1093714792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 30743) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000024927) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2014-03-30 |