| NPI | 1619959145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 101186) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-11776) |
| 207Q00000X Family Medicine (Licence: AR E-11776) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2020-03-13 |