| NPI | 1497015903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05117) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 1129) |
| 207P00000X Emergency Medicine (Licence: KS 05-38247) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2019-07-18 |