| NPI | 1275529638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101047307) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0041580) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2019-10-29 |