| NPI | 1891772737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 38238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD11633) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2014-06-13 |