| NPI | 1609981752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0000X Family Medicine Adolescent Medicine (Licence: TN MD016565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 018656) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2010-09-10 |