| NPI | 1982636510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2006-00611) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2006-00611) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2013-07-15 |