| NPI | 1164661203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 27649) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: NC 27649) |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2011-06-21 |