| NPI | 1558723577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME147527) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 88933) |
| 207Q00000X Family Medicine (Licence: AL 38457) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2021-09-14 |