| NPI | 1114913563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 30405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 30405) |
| 207Q00000X Family Medicine (Licence: NM MD2010-0156) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2022-02-10 |