| NPI | 1447296207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 7737A) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WY 7737A) |
| 207Q00000X Family Medicine (Licence: WY 7737A) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2015-08-04 |