| NPI | 1497096804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102204764) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017672) |
| Enumeration Date | 2013-03-09 |
| Last Update Date | 2021-03-20 |