| NPI | 1366556201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD17353) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: TN MD0000017353) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: TN MD17353) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2014-09-10 |