| NPI | 1356516850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 53579) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2011-01062) |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2014-10-31 |