| NPI | 1477569986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 25691) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: SC 25691) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2025-07-27 |