| NPI | 1922327568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 078692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK MEDS7915) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2024-07-08 |