| NPI | 1932327210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0032343) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DC MD14224) |
| 208D00000X General Practice (Licence: HI MD-15030) | |
| 208D00000X General Practice (Licence: CA G88619) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-07-04 |