| NPI | 1205806460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SD 2178) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 27171) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2010-09-01 |