| NPI | 1376782201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 295635) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q4345) |
| 207P00000X Emergency Medicine (Licence: OH 35.139318) | |
| 207Q00000X Family Medicine (Licence: MD D0068980) | |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2022-03-18 |