| NPI | 1487034831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R4233) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME165198) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2024-10-21 |