| NPI | 1104099936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 063045) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301088702) |
| 207P00000X Emergency Medicine (Licence: ME td091110) | |
| 207P00000X Emergency Medicine (Licence: TX P2080) | |
| 207P00000X Emergency Medicine (Licence: SC 33294) | |
| 207P00000X Emergency Medicine (Licence: FL ME 109750) | |
| 207P00000X Emergency Medicine (Licence: MD D0071741) | |
| 207P00000X Emergency Medicine (Licence: NC 169289) | |
| 207P00000X Emergency Medicine (Licence: MO 2012007898) | |
| Enumeration Date | 2008-04-13 |
| Last Update Date | 2012-06-20 |