| NPI | 1164494241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 5591A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 5591AWY) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2023-03-07 |