| NPI | 1952712812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022006443) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2022006443) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MO 2022006443) | |
| 208D00000X General Practice (Licence: MO 2022006443) | |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2024-03-06 |