| NPI | 1700825270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 26358) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 26358) |
| 208D00000X General Practice (Licence: NC 30731) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-07-30 |