| NPI | 1669566501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 54544) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 054544) |
| 207P00000X Emergency Medicine (Licence: SC 23245) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-11-12 |