| NPI | 1528025780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 009505) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS3583) |
| 207Q00000X Family Medicine (Licence: FL OS3583) | |
| 207Q00000X Family Medicine (Licence: MI 009505) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2007-08-22 |