| NPI | 1902932213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 29153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 29153) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2018-06-15 |