| NPI | 1164428371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI MD-11527) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD34402) |
| 207P00000X Emergency Medicine (Licence: AK 2644) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2007-07-08 |