| NPI | 1700141520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 2629) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 2629) |
| 207P00000X Emergency Medicine (Licence: TN DO0000002629) | |
| 207P00000X Emergency Medicine (Licence: KY 04606) | |
| 207Q00000X Family Medicine (Licence: TN DO0000002629) | |
| 207Q00000X Family Medicine (Licence: KY 04606) | |
| 208D00000X General Practice (Licence: TN 2629) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2021-06-10 |