| NPI | 1851382469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM A-960-92) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM A96092) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2025-05-12 |