| NPI | 1245303429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00035749) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 8006A) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-10-23 |