| NPI | 1154459188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00048028) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD430170) |
| 207P00000X Emergency Medicine (Licence: TX N5985) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2015-10-16 |