| NPI | 1992748768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME87373) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 20030) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2021-01-27 |