| NPI | 1760474084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 13928) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 13928) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2013-07-26 |