| NPI | 1073506192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 30816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 30816-020) |
| 208600000X Surgery (Licence: WI 30816-020) | |
| 213E00000X Podiatrist (Licence: WI 633-025) | |
| 213ES0131X (Licence: WI 633-025) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2022-06-23 |