| NPI | 1669798880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2011041711) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2011041711) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2021-04-20 |