| NPI | 1629051891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 21580) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 21580020) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2026-06-22 |