| NPI | 1124068945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 20291) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: SC 20291) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-08-03 |