| NPI | 1538258348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2007024441) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2007024441) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2026-09-01 |