| NPI | 1417983180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 26936) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 19571) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2013-11-09 |