| NPI | 1730381864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 203186) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.203186) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2024-06-21 |