| NPI | 1255768313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 077799) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL unknown) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2018-03-12 |