| NPI | 1245598127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 61291-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: WI 61291-20) | |
| 208D00000X General Practice (Licence: WI 61291-20) | |
| 208M00000X Hospitalist (Licence: WI 61291-20) | |
| 202C00000X Independent Medical Examiner (Licence: WI 61291-20) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2016-01-12 |