| NPI | 1356532576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 316586-1205) |
| Additional Taxonomies | 207PT0002X Emergency Medicine, Medical Toxicology (Licence: PA MD 429410) |
| 207P00000X Emergency Medicine (Licence: UT 316586-1205) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-12-14 |