| NPI | 1134117039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 5661A) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WY 5661A) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2015-09-30 |