| NPI | 1104879253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 11701R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD.08928R) |
| 208D00000X General Practice (Licence: LA MD.08928R) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2009-09-02 |