| NPI | 1164672499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 147303) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01069587A) |
| 207P00000X Emergency Medicine (Licence: OH 35 096666) | |
| 207P00000X Emergency Medicine (Licence: LA MD.203768) | |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2019-05-17 |