| NPI | 1235438599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301098225) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301098225) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2018-04-26 |