| NPI | 1174573133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9901193) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101230818) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2017-02-23 |