| NPI | 1861602815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA md.05842r) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA md.05842r) |
| 207R00000X Internal Medicine (Licence: LA md.05842r) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |