| NPI | 1134159171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 29593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000038388) |
| 207Q00000X Family Medicine (Licence: GA 78348) | |
| 207Q00000X Family Medicine (Licence: AL MD.41971) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2023-12-11 |