| NPI | 1336130111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 053230) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 53230) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2016-08-22 |