| NPI | 1164841565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2017-0422) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A150085) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2017-10-13 |