| NPI | 1588645196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD40259) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200400596) |
| 207Q00000X Family Medicine (Licence: TN 40259) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2013-03-15 |