| NPI | 1679935381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 26900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9409057) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2020-04-14 |