| NPI | 1336261395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI GP043454) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI GP043454) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI GP043454) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2015-09-14 |