| NPI | 1033371117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC MD38112) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD441880) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2015-09-11 |