| NPI | 1649567678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 005229) |
| 207P00000X Emergency Medicine (Licence: LA MD.207135) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2015-01-28 |