| NPI | 1346228962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 55657) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 055657) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: GA 55657) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2011-12-01 |