| NPI | 1174687990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM A-1808-14) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT014178) |
| 208D00000X General Practice (Licence: NE 548) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2024-01-17 |