| NPI | 1881676856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO0000000604) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN DO0604) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2012-12-17 |