| NPI | 1982611307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 85-308) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM 85-308) |
| 207R00000X Internal Medicine (Licence: NM 85-308) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-03-23 |