| NPI | 1487630851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME96288) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 042718) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2008-05-16 |