| NPI | 1871669960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101044923) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101044923) |
| 261QU0200X Clinic/Center Urgent Care | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2016-11-23 |