| NPI | 1508087255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 7584446-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101016868) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2010-10-01 |