| NPI | 1265500938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID M-11231) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME EC-06-1097) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-09-12 |