| NPI | 1649454257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 246453) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 246453) |
| 207P00000X Emergency Medicine (Licence: KS 0433645) | |
| 207Q00000X Family Medicine (Licence: MT 103677) | |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2023-03-28 |