| NPI | 1225320583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-37555) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA MD-43350) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2024-09-05 |