| NPI | 1497702567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 19633) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 052675) |
| 208D00000X General Practice (Licence: GA 052675) | |
| 207P00000X Emergency Medicine (Licence: SC 19633) | |
| 207R00000X Internal Medicine (Licence: SC 19633) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2009-11-05 |