| NPI | 1508073586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS 1202) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA D12345) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2009-01-07 |