| NPI | 1285688226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 7765) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000035732) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2016-04-25 |