| NPI | 1992768477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 193200000X Multi-Specialty (Licence: CT 040028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 9376) |
| 207P00000X Emergency Medicine (Licence: KY 44050) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2016-06-21 |