| NPI | 1184756603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD28407) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 6579383-1205) |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2011-10-27 |