| NPI | 1801824651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.019412) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.019412) |
| 207Q00000X Family Medicine (Licence: LA 019412) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2024-02-01 |