| NPI | 1497775100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 12294A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS006243L) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-11-11 |