| NPI | 1770570038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MS 09179) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 09179) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2008-01-28 |