| NPI | 1164449708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO R9174) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 18006) |
| 207P00000X Emergency Medicine (Licence: NC 29135) | |
| 207P00000X Emergency Medicine (Licence: NE 19319) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-02-08 |