| NPI | 1255398350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 22163) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD22163) |
| 207P00000X Emergency Medicine (Licence: SC 22163) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2018-10-02 |