| NPI | 1669765756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 69566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 69566) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2014-11-03 |