| NPI | 1265641781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA G53120) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00030521) |
| 207Q00000X Family Medicine (Licence: ID M-6149) | |
| 207Q00000X Family Medicine (Licence: HI MD-11937) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-08-07 |