| NPI | 1104850171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 0420011703) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME 017953) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-12-19 |