| NPI | 1659711455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15650) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 3011) |
| 207Q00000X Family Medicine (Licence: VA 0116026356) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2023-12-28 |