| NPI | 1700985108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 15734) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 15734) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-07-08 |