| NPI | 1215162524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME125247) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 252676) |
| 207P00000X Emergency Medicine (Licence: LA MD.204123) | |
| Enumeration Date | 2009-05-17 |
| Last Update Date | 2016-04-16 |