| NPI | 1235116963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NE 17445) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 047443) |
| 207P00000X Emergency Medicine (Licence: KS 0424377) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2010-07-29 |