| NPI | 1467443713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 042549) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 042549) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2024-03-12 |