| NPI | 1023020963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 58862) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 58862) |
| 207P00000X Emergency Medicine (Licence: AL AL15443) | |
| 207P00000X Emergency Medicine (Licence: AL L-2654) | |
| 207Q00000X Family Medicine (Licence: AL 27554) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: GA 58862) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AL 27554) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2023-11-01 |