| NPI | 1760864102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301108304) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60940356) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2022-02-14 |