| NPI | 1124118724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101055416) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 358219-1205) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2010-10-08 |