| NPI | 1770633042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 26087-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 26087) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2008-07-23 |