| NPI | 1104147297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 0000018100) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME121944) |
| Enumeration Date | 2010-06-13 |
| Last Update Date | 2019-01-30 |