| NPI | 1285741850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME97982) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME97982) |
| 207Q00000X Family Medicine (Licence: TX m2817) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-12-15 |