| NPI | 1164461729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 204497) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AZ LT0063) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-12-14 |