| NPI | 1356637896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04722) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101019469) |
| 207P00000X Emergency Medicine (Licence: IA 04722) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-01-02 |