| NPI | 1679547848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 17920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 046835) |
| 207P00000X Emergency Medicine (Licence: FL ME46835) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2009-06-29 |