| NPI | 1609826486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C6852) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR C6852) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-05-10 |