| NPI | 1255518007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2024-01606) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 03371) |
| 208D00000X General Practice (Licence: GA 64776) | |
| 208D00000X General Practice (Licence: TN DO0000003188) | |
| 208D00000X General Practice (Licence: TN DO00000031) | |
| 207Q00000X Family Medicine (Licence: GA 64776) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 64776) | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2026-07-16 |