| NPI | 1437149887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-5879) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 015520) |
| 207L00000X Anesthesiology (Licence: ME 015520) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2011-09-12 |