| NPI | 1487865937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.202452) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 202452) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2015-04-24 |