| NPI | 1215625587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 74183) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX V9727) |
| 208D00000X General Practice (Licence: AR E-19525) | |
| 208D00000X General Practice (Licence: NY 337015) | |
| 208D00000X General Practice (Licence: WA MD70039266) | |
| 208D00000X General Practice (Licence: GA 105365) | |
| 208D00000X General Practice (Licence: OR MD225538) | |
| 208D00000X General Practice (Licence: CA A-205948) | |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2026-02-27 |