| NPI | 1104080175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO1804) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ND 11593) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2014-02-25 |