| NPI | 1124319033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 37314) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 172980) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2014-07-18 |