| NPI | 1740522861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207271) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 78085) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2025-05-27 |