| NPI | 1932495306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15080) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 6544620) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2017-01-06 |