| NPI | 1568704088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-42458) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2014030364) |
| 208D00000X General Practice (Licence: MO 2014030364) | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2019-09-09 |