| NPI | 1558562561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME106311) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 63241) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2018-08-17 |