| NPI | 1598706194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 27820) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 27820020) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 27820) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2019-05-10 |