| NPI | 1043521123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME115272) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC 900101960) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2013-10-17 |