| NPI | 1205839248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD 26803) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101225081) |
| 207Q00000X Family Medicine (Licence: NC 36735) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2022-12-13 |