| NPI | 1013912229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 24552) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 24552) |
| 207P00000X Emergency Medicine (Licence: NC 24552) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2023-08-07 |