| NPI | 1093708331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 44108) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME 017968) |
| 207P00000X Emergency Medicine (Licence: FL ME0043960) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2015-04-03 |