| NPI | 1720373459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 60805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 52095) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2025-07-02 |