| NPI | 1730290545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-15626) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 3414601205) |
| 207Q00000X Family Medicine (Licence: OR MD172360) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-08-13 |