| NPI | 1194795955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 20659) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 00020659) |
| 207Q00000X Family Medicine (Licence: AL 00020659) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2025-02-10 |