| NPI | 1053493866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 86936) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 12036) |
| 208D00000X General Practice (Licence: WV 12036) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2023-02-22 |