| NPI | 1962407288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2005-01802) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI WT007666) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2008-05-20 |