| NPI | 1255334785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 17839) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301050169) |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2007-07-09 |