| NPI | 1700989969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6372524-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 16369) |
| 207P00000X Emergency Medicine (Licence: UT 6372524-1205) | |
| 207P00000X Emergency Medicine (Licence: NM MD2022-0625) | |
| 207Q00000X Family Medicine (Licence: NM MD2022-0625) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2024-04-30 |