| NPI | 1043396609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 49764) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.204989) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2015-04-14 |