| NPI | 1528043759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 21014) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 21014) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2021-01-25 |