| NPI | 1609860394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 24175) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 10164) |
| 207Q00000X Family Medicine (Licence: NH 10164) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2023-10-13 |