| NPI | 1639277429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI BP2711605) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 31958) |
| 207Q00000X Family Medicine (Licence: MI 4301061515) | |
| 208D00000X General Practice (Licence: MI 4301061515) | |
| 207P00000X Emergency Medicine (Licence: MI BP2711605) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-11-18 |