| NPI | 1275563132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD218647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.32041) |
| 207Q00000X Family Medicine (Licence: NY NY175772) | |
| 207Q00000X Family Medicine (Licence: PA MD040318L) | |
| 207Q00000X Family Medicine (Licence: FL ME59088) | |
| 207P00000X Emergency Medicine (Licence: NY NY175772) | |
| 207P00000X Emergency Medicine (Licence: FL ME59088) | |
| 207P00000X Emergency Medicine (Licence: PA MD040318L) | |
| 207P00000X Emergency Medicine (Licence: AL MD.32041) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2025-09-26 |