| NPI | 1487866471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101017021) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2009030095) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-11-03 |