| NPI | 1538265749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-01888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD23535) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2021-06-03 |