| NPI | 1376592782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 18488) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY C0365) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2021-10-22 |