| NPI | 1306282421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A149206) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 27085) |
| 207P00000X Emergency Medicine (Licence: VA 0101260038) | |
| 207P00000X Emergency Medicine (Licence: NC 2016-01061) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2017-09-14 |