| NPI | 1588619795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL MD.28052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.28052) |
| 207P00000X Emergency Medicine (Licence: GA 30768) | |
| 207Q00000X Family Medicine (Licence: GA 30768) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2013-04-24 |