| NPI | 1720024425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME76518) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME76518) |
| 207Q00000X Family Medicine (Licence: GA 48092) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2024-05-02 |