| NPI | 1760410906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX G1450) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 4214A) |
| 207P00000X Emergency Medicine (Licence: CA C41480) | |
| 208D00000X General Practice (Licence: CO 0026376) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2019-02-04 |