| NPI | 1134269020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9500330) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9500330) |
| 208D00000X General Practice (Licence: NC 9500330) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2015-08-06 |