| NPI | 1447277074 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301060782) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 013990) | 
| 207P00000X Emergency Medicine (Licence: FL ME38898) | |
| Enumeration Date | 2006-07-17 | 
| Last Update Date | 2007-07-08 |