| NPI | 1083631618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 28747) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 28747) |
| 207P00000X Emergency Medicine (Licence: OH 79801) | |
| 207P00000X Emergency Medicine (Licence: VA 0101236147) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-06-05 |