| NPI | 1306848502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2005-01731) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME53526) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2015-05-21 |