| NPI | 1922251123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO0000003582) |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2025-03-05 |