| NPI | 1477765964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VT 0420012005) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AK 5620) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2013-10-10 |