| NPI | 1093042640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2012-00750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101249003) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2022-02-28 |