| NPI | 1457487787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 56230) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2002011271) |
| 208D00000X General Practice (Licence: MO 2002011271) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2021-12-21 |