| NPI | 1528099074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 7984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 7984) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MT 7984) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-12-18 |