| NPI | 1720087109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-26469) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 426469) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2009-09-15 |