| NPI | 1467428680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN TN030909) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S6017) |
| 207Q00000X Family Medicine (Licence: KY 47980) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2020-06-11 |