| NPI | 1225068083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2015-0219) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 75002) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2015-08-31 |