| NPI | 1528045333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301086868) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301086868) |
| 208D00000X General Practice (Licence: MI 4301086868) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2021-01-12 |