| NPI | 1033170337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 40854) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 40854-020) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2017-01-31 |