| NPI | 1346221157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000026800) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD26800) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2018-03-15 |