| NPI | 1467544148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 48126) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 28587) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-12-21 |