| NPI | 1225100142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP61148954) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NE 495) |
| 208D00000X General Practice (Licence: NE Nebraska495) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-11-16 |