| NPI | 1013903640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 00026726) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: HI MD-13539) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2009-06-17 |