| NPI | 1447514443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL TRN17991) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL TRN17991) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2015-02-20 |