| NPI | 1558478305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 041878) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CT 041878) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: CT 041878) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2025-09-24 |