| NPI | 1316948987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036.126675) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 38712) |
| 207P00000X Emergency Medicine (Licence: TN 11044) | |
| 207P00000X Emergency Medicine (Licence: CO 44100) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2014-05-16 |