| NPI | 1528284262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25274) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 37965) |
| 207P00000X Emergency Medicine (Licence: NE 25274) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2019-11-21 |