| NPI | 1073823415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 16146) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SC 16146) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2010-10-19 |