| NPI | 1508244435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 67624) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 28263) |
| 207Q00000X Family Medicine (Licence: VA 0101273638) | |
| 207Q00000X Family Medicine (Licence: WV 28253) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2023-10-25 |