| NPI | 1124055637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 2502) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: AZ 2502) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2011-01-11 |