| NPI | 1528055241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 47689) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 00023308) |
| 207P00000X Emergency Medicine (Licence: AL 23308) | |
| 207P00000X Emergency Medicine (Licence: TN 32150) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2015-09-03 |