| NPI | 1578977914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2017028836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014018103) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2022-02-11 |