| NPI | 1043479355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R-8377) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 4006) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2017-02-07 |