| NPI | 1275518102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 038667) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 27494) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2017-04-07 |