| NPI | 1568564326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301046165) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301046165) |
| 208D00000X General Practice (Licence: MI 4301046165) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2013-07-31 |