| NPI | 1003875501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-4470) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AR E-4470) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2014-02-10 |