| NPI | 1396787495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 30513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 30513) |
| 207Q00000X Family Medicine (Licence: TN MD0000014303) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-01-30 |