| NPI | 1679535785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD19091) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD190941) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2020-06-25 |