| NPI | 1336128016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 30315) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 30315) |
| 207P00000X Emergency Medicine (Licence: OH 35083060) | |
| 207P00000X Emergency Medicine (Licence: GA 89303) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2023-10-24 |