| NPI | 1104801760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ND 10785) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 40706) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2014-08-27 |