| NPI | 1558363689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 16397) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO0000001485) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2013-06-21 |