| NPI | 1477789725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 156777) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2012-01120) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2012-07-26 |