| NPI | 1770540916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 055294) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 55294) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-07-11 |