| NPI | 1801840962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8696821-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 11085) |
| 207Q00000X Family Medicine (Licence: NV 11085) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2021-09-30 |