| NPI | 1003891532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200101499) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2001-01499) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2017-05-05 |