| NPI | 1639275019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME96392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 058115) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2023-06-22 |