| NPI | 1629503180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A21000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OS021687) |
| 208D00000X General Practice (Licence: MI 5101024380) | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2024-06-27 |