| NPI | 1619913175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 220629) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 220629) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2011-03-02 |