| NPI | 1285014712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 57359) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME129120) |
| 207Q00000X Family Medicine (Licence: KY CO412) | |
| 207Q00000X Family Medicine (Licence: FL 21172) | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2025-09-25 |