| NPI | 1194953117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 1025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT013150) |
| 208D00000X General Practice (Licence: NE 1025) | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2019-08-28 |