| NPI | 1104140714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 51396) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 54490) |
| 207P00000X Emergency Medicine (Licence: MN 105759) | |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2016-01-27 |