| NPI | 1457380974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS-06366) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS6366) |
| 207Q00000X Family Medicine (Licence: FL OS-6366) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-07-21 |