| NPI | 1659352052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101034381) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101034381) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2011-11-08 |