| NPI | 1679736292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 34241) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 34241) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2025-06-13 |