| NPI | 1942243589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 34286) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101840515) |
| 207P00000X Emergency Medicine (Licence: GA 67481) | |
| 207P00000X Emergency Medicine (Licence: SC MD 34286) | |
| 207P00000X Emergency Medicine (Licence: NC 9701778) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2023-02-21 |