| NPI | 1104979590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME103531) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 24702) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2015-04-21 |