| NPI | 1710967930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301089476) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301089476) |
| 207P00000X Emergency Medicine (Licence: MI 4301089476) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2025-05-22 |