| NPI | 1508198243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN md0000005850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000005850) |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2010-02-05 |