| NPI | 1487613683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 221207-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA A02285) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2009-12-02 |