| NPI | 1164472791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME48896) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA G87682) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2009-03-04 |