| NPI | 1710964473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 25261) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 25261) |
| 207Q00000X Family Medicine (Licence: NC 25261) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2011-12-22 |