| NPI | 1205090156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D75128) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-13068) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2021-03-15 |