| NPI | 1477507333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AR E-5775) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 09578R) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2020-04-21 |