| NPI | 1164974598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 2412) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AK 2095) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2016-11-02 |