| NPI | 1902856719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 7932A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO624) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2013-11-13 |