| NPI | 1417120098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101017369) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI L1152636) |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2012-07-27 |