| NPI | 1588681035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 102469) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 29696) |
| 207P00000X Emergency Medicine (Licence: MO 102469) | |
| 207P00000X Emergency Medicine (Licence: ND 4352) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2010-08-04 |