| NPI | 1750448981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD28596) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ID M-3948) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-10-28 |