| NPI | 1447756218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 320024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 320024) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2019-07-29 |