| NPI | 1245225168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MO 2005006929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 006929) |
| 207P00000X Emergency Medicine (Licence: MO 2005006929) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2009-09-09 |