| NPI | 1215294434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0081849) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0081849) |
| 207Q00000X Family Medicine (Licence: MD D0081849) | |
| 207P00000X Emergency Medicine (Licence: MD D0081849) | |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2025-09-24 |