| NPI | 1366768434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 206328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 206328) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2013-07-09 |