| NPI | 1356450530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 025686) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: GA 025686) |
| 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: GA 025686) | |
| 207PS0010X Emergency Medicine Sports Medicine (Licence: GA 025686) | |
| 207Q00000X Family Medicine (Licence: GA 025686) | |
| 207QA0000X Family Medicine Adolescent Medicine (Licence: GA 025686) | |
| 207QA0505X Family Medicine Adult Medicine (Licence: GA 025686) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: GA 025686) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: GA 025686) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-10-04 |