| NPI | 1104813625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200601789) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: NC 200601789) |
| 207P00000X Emergency Medicine (Licence: MS 39882) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2023-11-30 |