| NPI | 1558465021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 4560) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AZ 4560) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: AZ 4560) | |
| 207PH0002X Emergency Medicine, Hospice and Palliative Medicine (Licence: AZ 4560) | |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: AZ 4560) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: AZ 4560) | |
| 207PT0002X Emergency Medicine, Medical Toxicology (Licence: AZ 4560) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2014-03-05 |