| NPI | 1437198645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 40193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 39542) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-12-08 |