| NPI | 1790777936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 15972) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 15972) |
| 207P00000X Emergency Medicine (Licence: NE 15972) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2020-09-09 |