| NPI | 1750335584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL me63826) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME63826) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME63826) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME63826) | |
| 207QS1201X Family Medicine, Sleep Medicine (Licence: FL ME63826) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2019-04-11 |