| NPI | 1528148632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD47108) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-049561) |
| 207Q00000X Family Medicine (Licence: OH 35-049561) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2015-02-10 |