| NPI | 1104071224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR 150495) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TN MD37095) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2010-07-06 |