| NPI | 1205096351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 47434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL30976) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2015-03-30 |