| NPI | 1528021649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AR E4220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-4220) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2012-10-05 |