| NPI | 1275783722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 47886) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT189327) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2011-09-07 |