| NPI | 1770520926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 430107241) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301073241) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2018-11-09 |