| NPI | 1043206113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-31362) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 31362) |
| 207Q00000X Family Medicine (Licence: IA 31362) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2019-01-08 |