| NPI | 1083685002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9701826) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9701826) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2026-01-19 |