| NPI | 1942566195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-13338) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M-13338) |
| 207Q00000X Family Medicine (Licence: MT 99946) | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2023-06-05 |