| NPI | 1568447688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101240477) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 43474) |
| 207P00000X Emergency Medicine (Licence: VA 0101240477) | |
| 207P00000X Emergency Medicine (Licence: NC 2014-02031) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2024-08-07 |