| NPI | 1790734895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200400499) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200400499) |
| 207Q00000X Family Medicine (Licence: CA G184388) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2024-09-12 |