| NPI | 1154311256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-02945) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IA 02945) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2025-05-23 |