| NPI | 1184678336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV 9270) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 9270) |
| 207Q00000X Family Medicine (Licence: NV 9720) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2016-07-22 |