| NPI | 1649441486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 201892) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301091319) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2008-03-20 |