| NPI | 1568457463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R9D20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO R9D20) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2021-02-26 |