| NPI | 1538100417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO690) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL DO-690) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2012-10-22 |