| NPI | 1174529432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD39083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23073) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2015-05-19 |