| NPI | 1720001621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 27269) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL27269) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2022-09-07 |