| NPI | 1558327031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 35352) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MD D0059112) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2023-11-08 |