| NPI | 1407203888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-01875) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-10960) |
| 207P00000X Emergency Medicine (Licence: NC 2019-01875) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 2019-01875) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2023-02-10 |