| NPI | 1558510248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A126358) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D0072607) |
| 207P00000X Emergency Medicine (Licence: VA 0101246777) | |
| 207P00000X Emergency Medicine (Licence: NY 247654) | |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2019-05-29 |