| NPI | 1114142270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 70965) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.203322) |
| 207Q00000X Family Medicine (Licence: GA 001960) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2021-06-15 |