| NPI | 1467772707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA ML60165773) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 57743) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2024-08-05 |