| NPI | 1669817656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 18149) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 62294) |
| 207Q00000X Family Medicine (Licence: KY R3387) | |
| 207Q00000X Family Medicine (Licence: AZ 62294) | |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2022-09-22 |