| NPI | 1184079915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301502346) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301502346) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2023-08-17 |