| NPI | 1629043302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 40855) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 23126) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2022-11-17 |