| NPI | 1235107772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 052047) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 24642) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: GA 052047) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2024-12-05 |