| NPI | 1407113103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2013-01608) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2013-01608) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2026-06-24 |