| NPI | 1336201169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-4964) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E4964) |
| 207P00000X Emergency Medicine (Licence: AR E-4964) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2011-05-24 |