| NPI | 1942247689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101008280) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101008280) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 008280) | |
| 208D00000X General Practice (Licence: MI 5101008280) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2021-11-09 |