| NPI | 1225138985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 24941) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 25494) |
| 207Q00000X Family Medicine (Licence: WI 24941) | |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2011-12-14 |