| NPI | 1366762478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IN 01079968) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD 60211363) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2018-04-27 |