| NPI | 1629285051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA MD44875) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 7631A) |
| 207P00000X Emergency Medicine (Licence: KY C1651) | |
| 207P00000X Emergency Medicine (Licence: WA MD60212389) | |
| 207P00000X Emergency Medicine (Licence: MI 4301090999) | |
| 207Q00000X Family Medicine (Licence: MI 4301090999) | |
| 207Q00000X Family Medicine (Licence: MN 62669) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2025-04-23 |