| NPI | 1164780284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 264661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11016464) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2022-02-11 |