| NPI | 1174657167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 050637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35090341) |
| 207P00000X Emergency Medicine (Licence: CT 50637) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2016-10-18 |