| NPI | 1164425963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA 4155) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2004-01333) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2012-05-01 |