| NPI | 1578946091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2018-0292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2015-0550) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2024-09-10 |