| NPI | 1528263647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 2168) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 3237) |
| 207L00000X Anesthesiology (Licence: TN DO2168) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 3237) | |
| 208D00000X General Practice (Licence: TN 2168) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2018-03-17 |