| NPI | 1376701243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.203200) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA PGY 1 Intern Permit) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2012-11-12 |