| NPI | 1801050976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2012010198) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008020892) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2017-01-31 |