| NPI | 1497105456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA MD-46620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10582) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2020-04-22 |