| NPI | 1063709657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 23015) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS T-2464) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2014-06-11 |