| NPI | 1700013661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 8939A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 8939A) |
| 207Q00000X Family Medicine (Licence: IN 11014834) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2023-07-29 |