| NPI | 1710116876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 312127) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q4357) |
| 207Q00000X Family Medicine (Licence: PA MD446144) | |
| 207Q00000X Family Medicine (Licence: ME MD19885) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2024-02-01 |