| NPI | 1174565147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 29424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD00024292) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-03-17 |