| NPI | 1356490676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA G85894) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CO 25284) |
| 207P00000X Emergency Medicine (Licence: MA 48132) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2014-06-02 |