| NPI | 1467680173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R8446) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 53754) |
| 207P00000X Emergency Medicine (Licence: MN 66040) | |
| 207Q00000X Family Medicine (Licence: MS 24086) | |
| 207Q00000X Family Medicine (Licence: FL ME113771) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2024-09-12 |