| NPI | 1174588297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD46616) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME92025) |
| 207P00000X Emergency Medicine (Licence: TN 46616) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2015-09-10 |