| NPI | 1295750545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J0621) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 21484) |
| 207P00000X Emergency Medicine (Licence: NH 7998) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2009-08-11 |