| NPI | 1790025294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301108513) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301108513) |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2023-04-13 |