| NPI | 1679538326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD53100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 15513) |
| 207Q00000X Family Medicine (Licence: NC 2007-01282) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2015-07-27 |