| NPI | 1376568782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101056285) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA RESIDENT) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-02-19 |