| NPI | 1528061223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 19791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 29545) |
| 207V00000X Obstetrics & Gynecology (Licence: TN 19791) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2016-08-16 |