| NPI | 1477507713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 23848) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD.24399) |
| 207Q00000X Family Medicine (Licence: NC 2006-00448) | |
| 207Q00000X Family Medicine (Licence: AL MD.24399) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2025-08-26 |