| NPI | 1699857136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 20218) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 20218) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-02-10 |