| NPI | 1265697254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS10435) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS100435) |
| 208D00000X General Practice (Licence: FL OS100435) | |
| Enumeration Date | 2008-07-19 |
| Last Update Date | 2020-06-16 |