| NPI | 1366704447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO CDRH.0058756) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DE C-0012011) |
| 207P00000X Emergency Medicine (Licence: NY 9312157) | |
| 207P00000X Emergency Medicine (Licence: PA MD451912) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2018-06-29 |