| NPI | 1417086547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: TN 44878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 44878) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: TN 44878) | |
| 208M00000X Hospitalist (Licence: TN 44878) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2025-06-11 |