| NPI | 1366480014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000027485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 69243) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2023-05-25 |