| NPI | 1578552410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101232005) |
| 207Q00000X Family Medicine (Licence: TN MD34440) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-02-10 |