| NPI | 1811982556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 00017681) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 17681) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2008-06-05 |