| NPI | 1205977451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-00660) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-117010) |
| 207P00000X Emergency Medicine (Licence: MI 5101018516) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2012-09-13 |