| NPI | 1063577377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KS 04-46567) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA ML002796) |
| 207Q00000X Family Medicine (Licence: PA ML002796) | |
| 207Q00000X Family Medicine (Licence: WV 22698) | |
| 208D00000X General Practice (Licence: TN 42991) | |
| 208D00000X General Practice (Licence: OK 37440) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2023-02-08 |