| NPI | 1104933043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 34003814H) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A 5228) |
| 207P00000X Emergency Medicine (Licence: ME 1139) | |
| 207P00000X Emergency Medicine (Licence: FL OS-10241) | |
| 207P00000X Emergency Medicine (Licence: WI 55011-21) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2012-02-09 |