| NPI | 1801050976 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 81062) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2012010198) | 
| 207Q00000X Family Medicine (Licence: MO 2008020892) | |
| Enumeration Date | 2008-07-17 | 
| Last Update Date | 2025-06-25 |