| NPI | 1104083757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 49702) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2010-01559) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2013-08-27 |