| NPI | 1164463113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID O-266) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O266) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-09-01 |