| NPI | 1194743245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 54721) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2009-00607) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2009-06-04 |