| NPI | 1871580035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 159091) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 34658) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2008-05-05 |