| NPI | 1417966573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 102762) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 102762) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-09-04 |