| NPI | 1245457290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 079500) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2007-00309) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-03-26 |