| NPI | 1992779912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 33883) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 033883) |
| 208D00000X General Practice (Licence: CT 033883) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2019-09-16 |