| NPI | 1477950673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 24130) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 24130) |
| 207Q00000X Family Medicine (Licence: MS 24130) | |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2018-05-01 |