| NPI | 1760409387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2016-02245) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 38636) |
| 207P00000X Emergency Medicine (Licence: MI 4301066056) | |
| 207Q00000X Family Medicine (Licence: MI 4301066056) | |
| 207Q00000X Family Medicine (Licence: NC 2016-02245) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-10-17 |