| NPI | 1053579987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A109869) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 46513) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2013-02-01 |