| NPI | 1356404776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD9119) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 00009119) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2019-10-08 |