| NPI | 1053362889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 56686-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 22685) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2012-05-04 |