| NPI | 1831174390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL DO.339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 02283) |
| 207Q00000X Family Medicine (Licence: AL DO.339) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2013-01-10 |