| NPI | 1285623983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101029112) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0034489) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2007-07-08 |