| NPI | 1568630010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD28356) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 6353353-1205) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-07-30 |