| NPI | 1770630253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 55506-21) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2005-01282) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2011-07-07 |