| NPI | 1578728002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 44208) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 44208) |
| 207Q00000X Family Medicine (Licence: TN 51876) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2020-12-03 |