| NPI | 1861463879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 322426) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 322426) |
| 207Q00000X Family Medicine (Licence: IN 02004648A) | |
| 207Q00000X Family Medicine (Licence: MI 5101016313) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2021-06-11 |