| NPI | 1730186032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 46486) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 49839) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2018-01-02 |