| NPI | 1932300134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN DO0000001488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A5627) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NJ 25MB07769000) | |
| 208D00000X General Practice (Licence: TN DO0000001488) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-12-09 |