| NPI | 1417908930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301055215) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301055215) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2011-12-15 |