| NPI | 1053377416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME24502) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9701850) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |