| NPI | 1881680130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-03446) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA DO-03446) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: IA DO-03446) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2025-07-07 |