| NPI | 1659369916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 203257) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 00026283) |
| 207Q00000X Family Medicine (Licence: AL 00026283) | |
| 207Q00000X Family Medicine (Licence: HI 13863) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2021-10-06 |