| NPI | 1902398407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA ML60863184) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 75407-20) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2024-09-30 |