| NPI | 1174502280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT 35909) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 9900962) |
| 207P00000X Emergency Medicine (Licence: GA 036592) | |
| 207P00000X Emergency Medicine (Licence: FL ME112439) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2016-09-01 |