| NPI | 1144297599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 11449A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R5P19) |
| 207P00000X Emergency Medicine (Licence: MO R5P19) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2018-04-23 |