| NPI | 1659466100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 29094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L.2713) |
| 207P00000X Emergency Medicine (Licence: AL L-2713) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2012-09-06 |