| NPI | 1578581534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R7712) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA MD37460) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-01-08 |