| NPI | 1609161124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL MD.32561) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AL MD.32561) |
| 207Q00000X Family Medicine (Licence: AL MD.32561) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2017-08-01 |