| NPI | 1396185765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 23688) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 23688) |
| 207Q00000X Family Medicine (Licence: MS T-2649) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2017-09-28 |