| NPI | 1841364171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9700978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO0000001545) |
| 207Q00000X Family Medicine (Licence: TN DO000001545) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2024-04-10 |