| NPI | 1154647394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2013-00593) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 164908) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2013-07-29 |