| NPI | 1114970480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS006991L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA BD2074665) |
| 207P00000X Emergency Medicine (Licence: PA OS006991L) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-03-07 |