| NPI | 1285875856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 31587) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 35635) |
| 207P00000X Emergency Medicine (Licence: GA 030759) | |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2015-02-07 |