| NPI | 1780625749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2008014375) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 33651) |
| 207Q00000X Family Medicine (Licence: MO 2008014375) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2015-04-15 |