| NPI | 1285016311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO0000003381) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN DO0000003381) |
| 207P00000X Emergency Medicine (Licence: VA 0102205572) | |
| 207Q00000X Family Medicine (Licence: VA 0102205572) | |
| 208D00000X General Practice (Licence: MI 5101021975) | |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2019-07-24 |