| NPI | 1518156181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-02015) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2013-02015) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2020-11-19 |