| NPI | 1629384581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207957) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD P25907) |
| 207P00000X Emergency Medicine (Licence: LA MD.207957) | |
| Enumeration Date | 2010-08-29 |
| Last Update Date | 2019-11-26 |