| NPI | 1326034729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 13315) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME57198) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME57198) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2018-03-17 |