| NPI | 1609877505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021023620) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 51402) |
| 207Q00000X Family Medicine (Licence: MO 2021023620) | |
| 207Q00000X Family Medicine (Licence: WI 39761-020) | |
| 207Q00000X Family Medicine (Licence: NM MD2015-0820) | |
| 208600000X Surgery (Licence: WI 39761-020) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2021-07-14 |