| NPI | 1881089993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 76895) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 58159) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2019-03-21 |