| NPI | 1538108261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR MD15934) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD15934) |
| 207Q00000X Family Medicine (Licence: OR MD15934) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2018-05-15 |