| NPI | 1558526384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: SC 34877) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 34877) |
| 207Q00000X Family Medicine (Licence: SC 34877) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NC 148647) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2023-05-03 |