| NPI | 1710185087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD27035) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00047078) |
| 207Q00000X Family Medicine (Licence: NJ 25MA08378200) | |
| 207Q00000X Family Medicine (Licence: NM MD2018-0953) | |
| 207Q00000X Family Medicine (Licence: WA MD00047078) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2021-02-05 |