| NPI | 1881636702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 104721) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101241398) |
| 207Q00000X Family Medicine (Licence: VA 0101241398) | |
| 207Q00000X Family Medicine (Licence: MO 2024000917) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-05-29 |