| NPI | 1578754636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS10481) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101017287) |
| 207Q00000X Family Medicine (Licence: GA 061148) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2009-04-02 |