| NPI | 1215978747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO256) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS3710) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-09 |