| NPI | 1386968303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD193145) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.206705) |
| 207P00000X Emergency Medicine (Licence: OR MD193145) | |
| 207Q00000X Family Medicine (Licence: LA MD.206705) | |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2023-01-13 |