| NPI | 1861454910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2001201862) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2001010862) |
| 207P00000X Emergency Medicine (Licence: MO 20012010862) | |
| 207Q00000X Family Medicine (Licence: MO 2001010862) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2020-08-27 |