| NPI | 1326013566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000034903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 041120) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2014-08-18 |