| NPI | 1184612095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 12662) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: AL 12662) |
| 207N00000X Dermatology (Licence: AL 12662) | |
| 207QA0505X Family Medicine Adult Medicine (Licence: AL 12662) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: AL 12662) | |
| 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: AL 12662) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: AL 12662) | |
| 207RH0005X Internal Medicine Hypertension Specialist (Licence: AL 12662) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AL 12662) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2023-03-07 |