| NPI | 1215129515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102202951) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 2116) |
| 207P00000X Emergency Medicine (Licence: MI 5101017465) | |
| 208D00000X General Practice (Licence: MI 5101017465) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2022-02-17 |