| NPI | 1336406180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-02514) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2016-02514) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2026-01-22 |