| NPI | 1205213394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 52091) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 69718-20) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2019-08-27 |