| NPI | 1952388746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 10927) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 10927) |
| 207Q00000X Family Medicine (Licence: NC 27092) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2020-12-22 |