| NPI | 1720373111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 10570A) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: UT 12267275-8904) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2023-05-26 |