| NPI | 1891963591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO 2589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS 10282) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2015-01-13 |