| NPI | 1083949648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: MO R2C88MD) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO R2C88MD) |
| 208D00000X General Practice (Licence: MO R2C88MD) | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2009-10-14 |