| NPI | 1023044021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD19597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD19597) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OR MD19597) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2007-07-08 |