| NPI | 1255719902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 339488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 58209) |
| 207P00000X Emergency Medicine (Licence: IN 01081151A) | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2026-02-16 |