| NPI | 1831249754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2008-00169) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DE C1-0008176) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2009-02-27 |