| NPI | 1194783472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR E-3967) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-3967) |
| 207Q00000X Family Medicine (Licence: GA 91108) | |
| 207Q00000X Family Medicine (Licence: OH 34C.000045) | |
| 207Q00000X Family Medicine (Licence: TX T2895) | |
| 207Q00000X Family Medicine (Licence: AR E-3967) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2025-03-03 |