| NPI | 1801868526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019030505) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2019030505) |
| 207Q00000X Family Medicine (Licence: IA 22603) | |
| 207P00000X Emergency Medicine (Licence: IA 22603) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2023-10-04 |