| NPI | 1578539672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 43829) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 00024642) |
| 207Q00000X Family Medicine (Licence: TN 43065) | |
| 207P00000X Emergency Medicine (Licence: KY 43829) | |
| 207P00000X Emergency Medicine (Licence: TN 43065) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2015-03-07 |