| NPI | 1306808043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD17878) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD17878) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2015-11-05 |