| NPI | 1841451259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY TL7448) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX N3484) |
| 208D00000X General Practice (Licence: HI DOS-1365) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2022-09-23 |