| NPI | 1124043120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO1936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 02971) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2022-03-15 |