| NPI | 1801862313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO0000002329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201997) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2023-04-26 |