| NPI | 1114214962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012025750) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2012025750) |
| 207Q00000X Family Medicine (Licence: MO 2011017869) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2022-05-17 |