| NPI | 1740253913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 38769) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000034017) |
| 207Q00000X Family Medicine (Licence: MS MS16168) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2010-03-04 |