| NPI | 1457319121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 8271) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 013592) |
| 207P00000X Emergency Medicine (Licence: WI 43183) | |
| 208D00000X General Practice (Licence: MI 5101013592) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2012-03-29 |