| NPI | 1164457875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 215812) |
| Additional Taxonomies | 171W00000X Contractor (Licence: CA A88238) |
| 207P00000X Emergency Medicine (Licence: CA A88238) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2008-10-16 |