| NPI | 1104802479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R7F41) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO R7F41) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2015-03-11 |