| NPI | 1780679118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1545) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2007-00071) |
| 207Q00000X Family Medicine (Licence: VA 0102201388) | |
| 207Q00000X Family Medicine (Licence: NC 2007-00071) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2021-03-01 |