| NPI | 1528079910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000016695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 16695) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2016-11-16 |