| NPI | 1467677328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: RI LP00073) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60071509) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2010-08-05 |