| NPI | 1063602779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101247199) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A104862) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2013-10-17 |