| NPI | 1740248806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 26761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD24598) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 24598) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: TN 24598) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-11-05 |