| NPI | 1285614479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 18892) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 18892) |
| 207P00000X Emergency Medicine (Licence: NC 2013-02298) | |
| 207Q00000X Family Medicine (Licence: NC 2013-02298) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2025-03-05 |