| NPI | 1891735650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME132651) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX J8368) |
| 207Q00000X Family Medicine (Licence: TX J8368) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-06-27 |