| NPI | 1114992823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 16158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA mdooo23980) |
| 207P00000X Emergency Medicine (Licence: NH 16158) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2013-08-14 |