| NPI | 1417096595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 5548A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 5548A) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2008-07-29 |