| NPI | 1811124266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-02059) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 201002059) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2023-10-18 |