| NPI | 1750487922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-03054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 3054) |
| 207P00000X Emergency Medicine (Licence: IA 3054) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2025-12-22 |