| NPI | 1013961986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 19010) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME58598) |
| 207P00000X Emergency Medicine (Licence: KY 19010) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2014-01-13 |