| NPI | 1922064823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 20089) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 20089) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-03-07 |