| NPI | 1477645760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101241207) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX M3744) |
| 207P00000X Emergency Medicine (Licence: VA 0101241207) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-08-21 |