| NPI | 1881629525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 97-55) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM 97-55) |
| 207P00000X Emergency Medicine (Licence: UT 344862-1205) | |
| 207Q00000X Family Medicine (Licence: NH 14379) | |
| 208D00000X General Practice (Licence: NH 14379) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-05-14 |