| NPI | 1457314007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000037467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 24458) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2008-04-10 |