| NPI | 1356646434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD47136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME107156) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2011-08-04 |