| NPI | 1265852586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 142949) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 306730) |
| 207Q00000X Family Medicine (Licence: OR MD187008) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2024-07-11 |