| NPI | 1194723494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 2002-0473) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 6248A) |
| 207Q00000X Family Medicine (Licence: TN MD0000041095) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2020-01-29 |