| NPI | 1740229384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 21795) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 33092) |
| 207P00000X Emergency Medicine (Licence: NE 21795) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2011-07-20 |