| NPI | 1780692079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 56034) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME61517) |
| 207Q00000X Family Medicine (Licence: SC 13573) | |
| 207Q00000X Family Medicine (Licence: AL 27686) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: VA 0101246311) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL 61517) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-02-15 |