| NPI | 1386642924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 35807) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME99257) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2009-09-22 |