| NPI | 1053381889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD26686) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2004022191) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2021-02-16 |