| NPI | 1326136151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102201489) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 261599-1) |
| 207P00000X Emergency Medicine (Licence: CA 20A11092) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2013-02-04 |