| NPI | 1194256404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD221690) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD61018288) |
| 207Q00000X Family Medicine (Licence: ID 8061772) | |
| 207P00000X Emergency Medicine (Licence: ME MD23163) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-01-02 |