| NPI | 1922596410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 63779) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 54896) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2022-01-26 |