| NPI | 1992890164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD161616) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM 82262) |
| 207P00000X Emergency Medicine (Licence: FL ME98777) | |
| 207P00000X Emergency Medicine (Licence: OR MD161616) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2017-01-31 |