| NPI | 1023060316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 4301038089) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301038089) |
| 207L00000X Anesthesiology (Licence: MI 4301038089) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2012-04-27 |