| NPI | 1316003098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2019018019) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H2206) |
| 207Q00000X Family Medicine (Licence: SC 36359) | |
| 207Q00000X Family Medicine (Licence: IL 036117506) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2019-06-18 |