| NPI | 1265744270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 303753) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A13953) |
| 207P00000X Emergency Medicine (Licence: LA 303753) | |
| 207Q00000X Family Medicine (Licence: MS 22078) | |
| 207Q00000X Family Medicine (Licence: NC 325939) | |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2025-06-13 |