| NPI | 1629245519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 17150) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: PR 17150) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: PR 17150) | |
| 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: PR 17150) | |
| Enumeration Date | 2008-05-11 |
| Last Update Date | 2011-05-24 |