| NPI | 1730131137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 14742) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 27103) |
| 207Q00000X Family Medicine (Licence: NC 27103) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2024-10-07 |