| NPI | 1972554822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD56839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 27248) |
| 208000000X Pediatrics (Licence: KY 27248) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2018-08-24 |