| NPI | 1063413466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101059198) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 44156) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2015-03-04 |