| NPI | 1972823581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R0489) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101252097) |
| 208D00000X General Practice (Licence: IN 01071675A) | |
| 207P00000X Emergency Medicine (Licence: PA MT200728) | |
| 207P00000X Emergency Medicine (Licence: PA MD453134) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2017-03-29 |