| NPI | 1568547990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 20102) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 20102) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2024-01-08 |