| NPI | 1255328787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD161507) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01055695a) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2020-11-05 |