| NPI | 1417307083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019014869) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2019014869) |
| 208D00000X General Practice (Licence: MO 2016018004) | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2024-05-08 |