| NPI | 1154559912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 40018) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 54934) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2013-08-14 |