| NPI | 1760938138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 71506-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10726) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2020-12-18 |