| NPI | 1205803327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 20243) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AL 20243) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: AL 20243) | |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: AL 20243) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: AL 20243) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: AL 20243) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: AL 20243) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AL 20243) | |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: AL 20243) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2015-06-11 |