| NPI | 1548245277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 053691) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 53691) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2016-04-19 |