| NPI | 1720124001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA 00028745) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 170438) |
| 207P00000X Emergency Medicine (Licence: GU M-1809) | |
| 208D00000X General Practice (Licence: WA 00028745) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2018-10-22 |