| NPI | 1609926211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 10633) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS MS10633) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2016-02-11 |