| NPI | 1205216728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA C183944) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: HI MD-20152) |
| 208D00000X General Practice (Licence: VA 0101261753) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2023-09-12 |