| NPI | 1487670907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2011-00890) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A92005) |
| 207P00000X Emergency Medicine (Licence: PA MD424686) | |
| 207P00000X Emergency Medicine (Licence: WV 21632) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2012-06-12 |