| NPI | 1053604165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 49552) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC MD36625) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2017-09-01 |