| NPI | 1023117272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 059306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 25191) |
| 207P00000X Emergency Medicine (Licence: GA 59306) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-03-07 |