| NPI | 1417956657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 21398) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 21398) |
| 208000000X Pediatrics (Licence: WV 21398) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2018-11-14 |