| NPI | 1972572196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD0000021755) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2015-01718) |
| 208600000X Surgery (Licence: TN MD0000021755) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2022-07-21 |