| NPI | 1194777953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 40228) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 45319) |
| 207Q00000X Family Medicine (Licence: VA 0101253346) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-06-16 |