| NPI | 1710095914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 125752) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IN 01038548A) |
| 207Q00000X Family Medicine (Licence: HI MD-11744) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2018-03-17 |