| NPI | 1144532342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 32073) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 50893) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2024-04-26 |