| NPI | 1356469134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 30505) |
| Additional Taxonomies | 282NR1301X General Acute Care Hospital, Rural (Licence: GA 058796) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-03-14 |