| NPI | 1104074517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 201100837) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC TL1410) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2021-12-23 |