| NPI | 1558411397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME103060) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL TRN10165) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2010-04-19 |