| NPI | 1073543328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01853) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 159498) |
| 207P00000X Emergency Medicine (Licence: VA 0101236399) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2019-08-27 |