| NPI | 1265753032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME114942) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 15174) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2013-11-25 |