| NPI | 1588972889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 005538) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV DO1822) |
| 207P00000X Emergency Medicine (Licence: TX Q5012) | |
| 207P00000X Emergency Medicine (Licence: AZ 005538) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2022-09-27 |