| NPI | 1134215759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R7C20) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MO R7C20) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2022-12-19 |