| NPI | 1568698223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT194574) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q1194) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2015-07-07 |