| NPI | 1669543807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO1806) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS9860) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-11-19 |