| NPI | 1982666970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 97626) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 33204) |
| 207Q00000X Family Medicine (Licence: IA 33204) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2024-01-24 |