| NPI | 1861832552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101020482) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5315059784) |
| 207Q00000X Family Medicine (Licence: MI 5315059784) | |
| 207P00000X Emergency Medicine (Licence: MI 5101020482) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2015-10-15 |