| NPI | 1669490348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0006927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 48027511205) |
| 207P00000X Emergency Medicine (Licence: UT 48027511205) | |
| 207Q00000X Family Medicine (Licence: CA G89199) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-02-13 |