| NPI | 1134410053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.207067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.207067) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2015-10-06 |