| NPI | 1356398952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NH LT-1161) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 25991) |
| 207P00000X Emergency Medicine (Licence: MO 2005030572) | |
| 207P00000X Emergency Medicine (Licence: NM MD2008-0651) | |
| 207P00000X Emergency Medicine (Licence: WI 18315) | |
| 208000000X Pediatrics (Licence: MA 212862) | |
| 208D00000X General Practice (Licence: WI 18315) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2021-02-03 |