| NPI | 1194019406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: ID O-0885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV ED0179A) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2020-04-02 |