| NPI | 1831147461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR R4476) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 11359) |
| 207P00000X Emergency Medicine (Licence: AR R-4476) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2012-04-11 |