| NPI | 1619955424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00017513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 46505) |
| 207Q00000X Family Medicine (Licence: NV 10440) | |
| 207P00000X Emergency Medicine (Licence: NV 46505) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2023-03-07 |