| NPI | 1225356470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 26236) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 40195) |
| 207Q00000X Family Medicine (Licence: NE 6219) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2020-01-07 |