| NPI | 1154333771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-27471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 237834) |
| 207P00000X Emergency Medicine (Licence: NY 2378341) | |
| 207Q00000X Family Medicine (Licence: KS 0427471) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2012-01-26 |