| NPI | 1104993997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-01868) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 49191) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-08-04 |