| NPI | 1790043784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2015021645) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2015021645) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2024-04-25 |