| NPI | 1316155757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200700515) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 43613) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2008-07-03 |