| NPI | 1053360867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL 37726) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 37726) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL 37726) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2023-03-07 |