| NPI | 1073576724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 12366) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 12366) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2008-03-14 |