| NPI | 1215114160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 55555) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2013-01177) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2013-11-26 |