| NPI | 1104096619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 11039) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: SC 11039) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2022-07-21 |