| NPI | 1447245816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 57059) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 17740) |
| 207P00000X Emergency Medicine (Licence: FL ME89433) | |
| 207P00000X Emergency Medicine (Licence: CO 45007) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2023-01-09 |