| NPI | 1033370192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201401070) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116020621) |
| 207Q00000X Family Medicine (Licence: TN DO0000002240) | |
| Enumeration Date | 2008-06-21 |
| Last Update Date | 2025-07-03 |