| NPI | 1477998664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2015-01934) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME142310) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2020-05-05 |