| NPI | 1043321995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR OR MD24267) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 43020-020) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-16 |