| NPI | 1003814179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021010406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 3714) |
| 207Q00000X Family Medicine (Licence: IA DO05122) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2021-05-05 |