| NPI | 1548209604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 28921) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 28921) |
| 207R00000X Internal Medicine (Licence: IL 036-070256) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2022-11-17 |