| NPI | 1124371604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 5567) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 2825) |
| Enumeration Date | 2012-10-20 |
| Last Update Date | 2021-04-22 |