| NPI | 1518901321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 3534) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD26613) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2021-05-24 |