| NPI | 1386661833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301049796) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101056520) |
| 207P00000X Emergency Medicine (Licence: WI 28752) | |
| 208D00000X General Practice (Licence: VA 0101056520) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2019-11-21 |