| NPI | 1255348678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 36046) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM 91-329) |
| 208D00000X General Practice (Licence: NM 94-329) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2017-10-30 |