| NPI | 1174956478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 070577) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 70577) |
| Enumeration Date | 2013-08-10 |
| Last Update Date | 2014-08-12 |