| NPI | 1194847699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME100212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.33147) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AL MD.33417) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2014-04-29 |