| NPI | 1588688873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 00025110) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 25110) |
| 208D00000X General Practice (Licence: AL 25110) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-06-25 |