| NPI | 1598773368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 5105A) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: WY 5105A) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2014-11-19 |