| NPI | 1508989450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 45555) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TN 45555) |
| 208M00000X Hospitalist (Licence: TN 45555) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2017-04-06 |