| NPI | 1770538514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-7543) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID M7543) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2017-05-06 |