| NPI | 1992903306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116018898) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35 093481) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2010-04-26 |