| NPI | 1558311175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 37696) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000037275) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2019-09-17 |