| NPI | 1699786079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 23962) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 23962) |
| 207Q00000X Family Medicine (Licence: NC 2009-01329) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2015-03-26 |