| NPI | 1134782584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 77289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11421) |
| 207Q00000X Family Medicine (Licence: WI 77289) | |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2024-05-24 |