| NPI | 1306080759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 66479) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME107771) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2016-07-05 |