| NPI | 1225236771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 29891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000029891) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2011-09-19 |