| NPI | 1306830013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101234489) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 36831) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2011-03-10 |