| NPI | 1598021073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000048230) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN MD0000048230) |
| 207Q00000X Family Medicine (Licence: FL ME105933) | |
| 207Q00000X Family Medicine (Licence: VA 0101246565) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2017-09-29 |