| NPI | 1528268703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101017376) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101017376) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2011-08-23 |