| NPI | 1235275132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 50125) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 50643) |
| 207P00000X Emergency Medicine (Licence: AZ 31717) | |
| 207P00000X Emergency Medicine (Licence: CT 42416) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-08 |