| NPI | 1619986924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 00010436) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 00010436) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-08-27 |