| NPI | 1669733580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 58317) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 58317) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: AZ 58317) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2021-03-02 |