| NPI | 1487145629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 75516) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11198) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2023-06-16 |