| NPI | 1649273467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 35670) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 34305) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2023-03-07 |