| NPI | 1770522823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 98-01310) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 98-01310) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2009-01-05 |