| NPI | 1982655932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID O276) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ID O-276) |
| 207P00000X Emergency Medicine (Licence: CA 9092) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2016-06-02 |