| NPI | 1639192412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD18668) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR MD18668) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2018-12-04 |